What is Barrett’s Esophagus?

Barrett’s esophagus is a concern because it predisposes you to esophageal cancer. With Barrett's the lining of the esophagus changes to lining similar to that found in the small intestines — this is abnormal in the esophagus...

Acid damage to the esophagus causes inflammation of the esophageal mucosa. This chronic inflammation can lead to a change in the mucosa to a different type that is more acid resistant. Barrett’s, which can lead to cancer, is diagnosed during an endoscopy. This change can be diagnosed when an esophageal biopsy is examined under the microscope. (A barium study cannot make the diagnosis because a biopsy is required.) This abnormal acid-resistant lining is called Barrett’s esophagus.

Barrett’s esophagus is a concern because it predisposes you to esophageal cancer. A finding of Barrett’s requires periodic follow-up with endoscopy and biopsy to determine whether any precancerous or cancerous changes have developed. These periodic tests can help diagnose esophageal cancer at an early stage or even possibly prevent it.

Most people with Barrett’s esophagus have chronic heartburn or acid reflux symptoms. In fact, because Barrett’s is more acid resistant, many patients report that their heartburn was worse when they were younger but is better now. Many studies have examined the prevalence (how frequently it occurs) of Barrett’s esophagus. An autopsy study by Cameron and associates published in Gastroenterology in 1999 demonstrated a rate of 376 cases per 100,000 people.

Barrett’s is usually not found in young children and is thought to be an acquired condition. It is found predominantly in males that are middle-aged and is more common in Caucasians and Hispanics. Patients with chronic acid reflux undergoing endoscopy have been studied, and about 10 –15% have Barrett’s esophagus. About 40–50% of endoscoped patients have normal exams and the rest (about 40%) have esophagitis. Thus, if you have chronic or long-standing heartburn symptoms and you are a white or Hispanic male between the ages of 40 and 60 years, you should see your doctor about an endoscopy test. Biopsies taken at endoscopy can reveal several different conditions that can resemble Barrett’s, and this can be confusing even to some doctors. The biopsies are sent to a specialized doctor called a pathologist . The pathologist looks for very specific changes in the lining of the esophagus called specialized intestinal metaplasia. The lining of the esophagus changes to lining similar to that found in the small intestines; this is abnormal in the esophagus. The key to the diagnosis is the presence of special cells called goblet cells. These cells normally occur in the small intestine and other organs and produce mucus. So, the idea is that the biopsy must show goblet cells; if there are no goblet cells, there is no Barrett’s.